Provider Demographics
NPI:1033577564
Name:CARRICO, DEENA DELYNNE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:DEENA
Middle Name:DELYNNE
Last Name:CARRICO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:DEENA
Other - Middle Name:DELYNNE
Other - Last Name:BALLARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 636961
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6961
Mailing Address - Country:US
Mailing Address - Phone:888-696-3541
Mailing Address - Fax:513-981-5015
Practice Address - Street 1:1169 CARRICO RD
Practice Address - Street 2:
Practice Address - City:FANCY FARM
Practice Address - State:KY
Practice Address - Zip Code:42039-9354
Practice Address - Country:US
Practice Address - Phone:270-832-4826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-28
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3010068363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily